J Korean Neurosurg Soc.  2019 Jul;62(4):467-475. 10.3340/jkns.2018.0199.

Minimally Invasive Surgery without Decompression for Hepatocellular Carcinoma Spinal Metastasis with Epidural Spinal Cord Compression Grade 2

• Jung JM
• Chung CK
• Kim CH
• Yang SH

• KMID: 2463678
• DOI: http://doi.org/10.3340/jkns.2018.0199

Abstract

OBJECTIVE
There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.
METHODS
Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3-6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).
RESULTS
The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).
CONCLUSION
MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.

Keyword

Carcinoma, Hepatocellular; Spine; Neoplasm metastasis; Decompression, Surgical; Instrumentation

MeSH Terms

Back Pain
Carcinoma, Hepatocellular*
Decompression*
Decompression, Surgical
Humans
Intensive Care Units
Life Expectancy
Minimally Invasive Surgical Procedures*
Neoplasm Metastasis*
Neurologic Manifestations
Operative Time
Prognosis
Retrospective Studies
Spinal Cord Compression*
Spinal Cord*
Spine
Walking

Figure

• 

  Fig. 1. Epidural spinal cord compression (ESCC) grade 2. A : Schematic representation of the ESCC grade 2. A grade of 2 indicates spinal cord compression but with cerebrospinal fluid visible around the cord. B : Current neurologic, oncologic, mechanical, and systemic decision framework of grade 2 ESCC proposed by Bilsky et al [3]. cEBRT : conventional external beam radiation therapy, SRS : stereotactic radiosurgery.

• 

  Fig. 2. Functional status (ECOG performance) changes for the minimally invasive surgery group and open surgery group pre-operatively and at postoperative 1 month and 3 months. ECOG : Eastern Cooperative Oncology Group.

• 

  Fig. 3. The mean ambulatory time for the minimally invasive surgery group was 183±33 days, and that for the open surgery group was 166± 36 days (p=0.814).

• 

  Fig. 4. The mean survival time for the minimally invasive surgery group was 216±38 days, and that for the open surgery group was 203±43 days (p=0.959).

Reference

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